Kidney Med. 2025 Apr 3;7(6):101001. doi: 10.1016/j.xkme.2025.101001. eCollection 2025 Jun.
ABSTRACT
RATIONALE & OBJECTIVE: To describe the use and effects of extracorporeal blood purification with hemoadsorption in managing severe complications after treatment with chimeric antigen receptor T-cells (CAR-T).
STUDY DESIGN: Retrospective analysis of a case series.
SETTING & PARTICIPANTS: Hematological department and intensive care unit from a single institution. Patients with hematological cancer who underwent CAR-T therapy between 2021 and 2023, developed severe toxicity, and were treated with hemoadsorption based on clinical indications.
RESULTS: Of 48 patients, extracorporeal blood purification was prescribed to 4 (8.3%): 3 with diffuse large B-cell lymphoma and 1 with mantle cell lymphoma. These patients experienced rapid increases in serum interleukin-6 and ferritin levels after CAR-T infusion, which progressed to severe cytokine release syndrome with hemodynamic instability and multiple-organ toxicity. Despite corticosteroid and anakinra rescue therapy after tocilizumab failure, extracorporeal blood purification with hemoadsorption was initiated at a mean of 5.2 ± 1.7 days following CAR-T infusion due to rapid clinical deterioration. The treatment was performed using continuous venovenous hemodiafiltration with an AN69ST hemofilter and a CytoSorb cartridge. One patient died 1 day after the initiation of blood purification because of concomitant cardiomyopathy progressing to multiple-organ failure. In the 3 surviving patients, interleukin-6 levels significantly decreased (from -18% to -95%), cytokine release syndrome resolved, and vasoactive support was reduced. Treatment-related complications were not observed.
LIMITATIONS: Small sample size, retrospective design, and lack of a predefined hemoadsorption therapy protocol.
CONCLUSIONS: A strategy based on hemoadsorption was safe and effective in mitigating inflammation and improving hemodynamics in patients with hematological cancer treated with CAR-T therapy who developed early severe toxicity.
PMID:40510619 | PMC:PMC12152617 | DOI:10.1016/j.xkme.2025.101001
